Depression treatment: a lifelong commitment?

Depression is associated with considerable disability, morbidity, and mortality. In many patients, depression follows a course of relapse and/or recurrence. However, there is significant evidence that the majority of patients with depressive disorders are undertreated and this imposes a substantial economic burden on society. The reasons for undertreatment include patient, provider, and healthcare system factors. It is vital that treatment be targeted appropriately to break the cycle of relapse/recurrence. Rather than short-term improvement of symptoms, the optimal outcome of treatment of depressive disorders should be full symptom resolution (remission) and long-term recovery. Patients with histories of recurrent depressive episodes may require long-term, indefinite treatment with antidepressants. Currently, few data exist on the outcome and appropriate duration of maintenance pharmacotherapy. The benefits of psychotherapy have recently been demonstrated in a 12-week, randomized, controlled study, which also includes a maintenance phase that has not yet been completed. Additional well-designed studies addressing these issues are urgently needed.